Casting jig for chair-side manufacture of customizable sculptable anatomical healing caps

ABSTRACT

Casting jigs, methods, and kits that may be used in manufacture of anatomical healing caps. A casting jig may include a body having one or more wells within the body, each well being open at a proximal end thereof and having a negative shape corresponding to an anatomical healing cuff body of a given tooth position. Each respective anatomical healing cuff body negative shape includes an asymmetrical cross-section and an irregular surface so that an anatomical healing cuff body having said shape is configured to provide substantially custom filling of at least an emergence portion of a void where a natural tooth once emerged or should have emerged from the void (e.g., in the case of a congenitally missing tooth). The casting jig may further include a socket at a distal end of each well that is configured to receive therein a dental implant or dental implant analog.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a divisional of U.S. patent application Ser.No. 14/327,869, filed Jul. 10, 2014, which is a continuation-in-part ofU.S. patent application Ser. No. 14/152,369, filed Jan. 10, 2014, nowU.S. Pat. No. 9,572,640, which is a continuation-in-part of U.S. patentapplication Ser. No. 13/633,387, filed Oct. 2, 2012, now U.S. Pat. No.8,628,327. The disclosure of each of the foregoing is incorporated byreference in its entirety.

BACKGROUND OF THE INVENTION 1. The Field of the Invention

This invention relates to casting jigs and associated methods formanufacturing healing caps or cuffs used in any stage of oral surgerywhere a tooth is extracted or missing. Such an example of oral surgeryincludes first stage oral surgery, for example, when an implant isinitially placed into a tooth void (e.g., whether the tooth is extractedor was congenitally or otherwise missing). The inventive healing caps orcuffs may also be used in any other dental surgery where it is desiredto preserve the emergence profile of gingival tissue surrounding one ormore teeth (e.g., second stage surgery, immediate or delayed implantplacement, etc.).

2. Background and Relevant Art

In modern dentistry, when one or more teeth are removed it is desirableto eventually replace the tooth or teeth with a prosthesis (e.g., acrown, bridge, etc.), although this is typically accomplished weekslater. Once the tooth is removed or missing, a dental implant is placedinto the bone tissue of the jaw to provide a secure foundation uponwhich a prosthesis can be supported. Typically, the site is allowed toheal for a period of time prior to installation of the permanentprosthesis. Currently, a device known as a healing cap, abutment, orcuff is coupled into the dental implant while the site is allowed toheal, to cap or cover the inside of the dental implant and to preservethe ability to re-access the dental implant once the site hassufficiently healed, when it is desired to install a prosthesis. Oncethe site has healed (e.g., typically 1.5 to 6 months after implantplacement), the healing cap, abutment, or cuff is removed, and a customprosthesis (e.g., a crown) may be installed, supported by the dentalimplant anchored within the jaw bone.

Existing dental healing caps, abutments, or cuffs, as well as themethods employed in their installation during immediate or subsequentdental placement and oral surgery exhibit several shortcomings. Inaddition, it would be advantageous to provide for the ability of apractitioner to manufacture his or her own healing caps exhibitingimproved characteristics.

BRIEF SUMMARY

The present invention is directed to casting jigs, methods, and kitsthat may be used in chair-side or small-scale manufacture ofcustomizable sculptable anatomical healing caps by a practitioner forinstallation into a patient. A casting jig may include a body having oneor more wells within the body, each well being open at a proximal endthereof and having a negative shape corresponding to an anatomicalhealing cuff body of a given tooth position. Each respective anatomicalhealing cuff body negative shape includes an asymmetrical cross-sectionand an irregular surface so that an anatomical healing cuff body havingsaid shape is configured to provide a substantially custom filling of atleast an emergence portion of a void where a natural tooth once emergedor should have emerged from the void (e.g., in the case of acongenitally missing tooth). The casting jig may further include asocket at a distal end of each well that is configured to releasablyreceive therein a dental implant or dental implant analog.

A related method of manufacture may include providing a casting jig(e.g., as described above). A dental implant or dental implant analogmay be releasably received within a corresponding socket of the castingjig. A curable or otherwise settable material is introduced into thewell of the casting jig (e.g., while in a flowable state), whichmaterial is allowed to set or cure so as to become rigid or hard. Uponsetting or curing, the resulting rigid material is in the shape of ananatomical healing cuff body having the desired asymmetricalcross-section and irregular surface so that the anatomical healing cuffbody is configured to provide substantially custom filling of at leastthe emergence portion of a void where a natural tooth once emerged orshould have emerged. The cured or set rigid anatomical healing cuff bodycan be easily removed from the casting jig for subsequent installationinto a dental implant which is in the jaw of a patient. In oneembodiment, the practitioner may further customize the anatomicalhealing cuff body by applying additional material thereto or removingmaterial therefrom (e.g., immediately prior to installation).

A related kit for use in manufacture of customizable sculptableanatomical healing caps may include a casting jig (e.g., as describedabove) and a curable or otherwise settable material for introductioninto a well of the casting jig to form an anatomical healing cuff bodyof an anatomical healing cap. Such a material may be flowable prior tosetting or curing, so as to allow its easy introduction into the wellprior to becoming rigid as a result of curing or setting.

Because the emergence portion of the various tooth positions are notidentical to one another (but they do remain substantially the same fromone person to another person when considering the same tooth position),different customizable sculptable anatomical healing caps can beprovided for the various tooth positions, which differ in the particularconfiguration of the enlarged cuff body of the respective healing cap.Use of such anatomical healing caps greatly improves the ability of thepractitioner to preserve desirable aesthetic characteristics of thegingival tissue surrounding the location of the dental implant andassociated crown or other prosthesis.

Furthermore, the presently described casting jigs and associated kitsand methods allow a practitioner to manufacture such anatomical healingcaps himself or herself, e.g., within one's own office. This may allowthe practitioner to reduce costs associated with purchase of expensivestate of the art healing caps, while providing a superior product whichprovides an anatomical, improved fit for better preservation of thegingival tissue.

These and other advantages and features of the present invention willbecome more fully apparent from the following description and appendedclaims, or may be learned by the practice of the invention as set forthhereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

To further clarify the above and other advantages and features of thepresent invention, a more particular description of the invention willbe rendered by references to specific embodiments thereof, which areillustrated in the appended drawings. It is appreciated that thesedrawings depict only typical embodiments of the invention and aretherefore not to be considered limiting of its scope. The invention willbe described and explained with additional specificity and detailthrough the use of the accompanying drawings in which:

FIG. 1A is a perspective view of an exemplary upper dental arch;

FIG. 1B is a perspective view of the dental arch of FIG. 1A in which acentral incisor has been removed, leaving a void;

FIG. 1C is a perspective view of the dental arch of FIG. 1B in which adental implant surgical drill is used to prepare an anchor hole in theunderlying bone for anchoring a dental implant;

FIG. 1D is a perspective view of the arch of FIG. 1C as an implant isbeing inserted (e.g., with the aid of a transfer coping);

FIG. 1E is a perspective view of the arch and into the void showing theimplant anchored into the bottom of the void;

FIG. 1F is a perspective view of the arch showing a state of the arthealing cuff coupled into the implant;

FIG. 2A is an exploded perspective view of an exemplary anatomicalhealing cap configured for filling the emergence portion of the voidformed when an upper central incisor is removed or is missing;

FIG. 2B is an assembled perspective view of the anatomical healing capof FIG. 2A;

FIG. 2C is a side elevation view of the anatomical healing cap of FIG.2B;

FIG. 2D is a top view of the anatomical healing cap of FIG. 2B;

FIG. 2E is a cross-sectional view through the anatomical healing cap ofFIG. 2B;

FIG. 2F is a perspective view similar to that of FIG. 2B, but showing analternative configuration at the distal dental implant end;

FIG. 2G is a perspective view similar to that of FIG. 2B, but showinganother alternative configuration at the distal dental implant end;

FIG. 2H is a perspective view similar to that of FIG. 2B, but showing analternative configuration including a removable grippable handle;

FIG. 3A is an exploded perspective view showing a related systemincluding an anatomical healing cap and an associated temporary crownform;

FIG. 3B is a perspective view showing the system of FIG. 3A with thetemporary crown form coupled over the anatomical healing cap;

FIG. 4A is a perspective view showing a portion of the cuff body of thehealing cap being customized by removal with a dental burr;

FIG. 4B is a perspective view showing the cuff body being customized bybuilding up with application of a dental material;

FIG. 4C is a perspective view of the arch of FIG. 1E in which ananatomical healing cap has been coupled into the implant, leaving no gapbetween the cuff body of the healing cap and the gingival tissuesurrounding the emergence portion of the void;

FIG. 4D is another perspective view of the arch of FIG. 4C;

FIG. 4E is another perspective view of the arch of FIG. 4C in which atemporary crown has been formed over the healing cap;

FIG. 5 is a perspective view of an exemplary casting jig formanufacturing anatomical healing caps;

FIG. 6 is a cross-sectional view through the casting jig of FIG. 5;

FIG. 7 is a cross-sectional view similar to FIG. 6, but in which thedental implant analog and the implant housing have been removed from thesocket below the well of the casting jig;

FIG. 8 is a perspective view showing positioning of an elongate body(e.g., a straw, an implant wrench, a temporary abutment, etc.) into therecessed connection of the implant or implant analog and introduction ofthe curable or otherwise settable material around the elongate body soas to form an anatomical healing cuff body while preserving accessthrough the cuff body to the implant or implant analog;

FIG. 9A is a cross-sectional view through the casting jig of FIG. 8 asthe anatomical healing cap is being formed;

FIG. 9B is a cross-sectional view through the casting jig of FIG. 8 inwhich a temporary abutment is used as a core around Which the anatomicalhealing cap is being formed;

FIG. 9C is a cross-sectional view through the casting jig of FIG. 8 inwhich a temporary abutment having a lower profile than that of FIG. 99is used as a core around which the anatomical healing cap is beingformed;

FIG. 9D is a cross-sectional view through the casting jig of FIG. 8,similar to that of FIG. 99, but illustrating an alternative embodiment;

FIG. 10 is an exploded perspective view of the anatomical healing capmanufactured using the casting jig next to the associated implantanalog;

FIG. 11 is a view of an anatomical healing cap formed using the castingjig and a coupling as the elongate body; and

FIG. 12 is a view of a pontic configured similar to the anatomicalhealing caps formed using the casting jig, but which does not include acentral access channel 138 or locking structure 150.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

I. Introduction

One problem with conventional healing caps and related methods of oralsurgery is that those features of the gingiva that provide much of thecharacteristic natural aesthetic appearance of natural teeth andadjacent gum tissue are almost always lost once a tooth is pulled andreplaced with a prosthesis. In particular, the gingival tissuesurrounding the crown of a natural tooth where it emerges (i.e., itsemergence profile) is lost during such procedures.

The gingival cuff refers to the generally scalloped pattern of thegingival tissue that is most prominently seen along the buccal surfaceof the teeth. The height of contour of the gingival cuff refers to thedifference between the most occlusal extension of the gingiva (i.e.,between teeth) as compared to its location at the center of a tooth.Generally, the height of contour of the gingival cuff is greatest at alocation between two adjacent teeth. In other words, the location of thegingival cuff extends occlusally to its greatest extent at this locationbetween the teeth. At a location corresponding to a buccal center faceof a tooth, the location of the gingival cuff exhibits its lowestocclusal extension.

When a natural tooth is pulled and eventually replaced with a customcrown or other prosthesis, much of the dynamic range of the previousheight of contour is lost because the gingival tissue between adjacentteeth recedes, and is lost.

Gingival tissue disposed between adjacent teeth is often referred to asthe interdental papilla. This tissue resides between the void resultingfrom the pulled tooth and the adjacent remaining tooth. As a result ofthe loss of the tooth, the interdental papilla may atrophy and fill thevoid over time. As a result, much of the interdental papilla tissue,particularly the initial and desirable aesthetic characteristics of thistissue, also tends to be lost upon removal of the natural tooth.

At the extreme gingival edge of the gingival cuff there is gingivaltissue that overlies the underlying jaw bone. This gingival tissuetypically exhibits a prominence in the buccal direction (i.e., it sticksout or protrudes bucally) and is often referred to as buccal prominence.While the gingival tissue over this bony tissue is not necessarily lost,the prominence by which the tissue sticks out bucally is typically lostwhen a natural tooth is pulled.

The present invention is directed to devices, kits, and methods allowingsmall-scale manufacture of customizable sculptable anatomical healingcaps, allowing the practitioner to chair-side manufacture the neededanatomical healing caps for use with any given patient. Because thehealing caps anatomically match the given tooth position where they areplaced, they provide custom filing of at least the emergence portion ofthe void resulting from removal of a selected tooth (or where a toothshould be in the case of a congenitally missing tooth). Because of theanatomical features of the healing cap, use of the healing capadvantageously allows the practitioner to better preserve the desirableaesthetic features of the gingival tissue surrounding and associatedwith natural teeth.

FIGS. 1A-1F illustrate an upper dental arch, as well as typical stepsemployed in removal of a tooth, installation of an implant, andplacement of a state of the art healing cuff or cap. For example, FIG.1A shows a person's upper dental arch 100 including central incisors102. Also apparent in FIG. 1A is the gingival cuff 104 where the naturalteeth emerge from the gingival tissue, and the typical height of contourwhere the highest contour H₂ is between two adjacent teeth, while thelowest contour or point along the gingival cuff is H₁, at the center ofthe buccal face of the teeth. The difference H between H₂ and H₁represents the height of contour associated with the natural teeth andgingival cuff prior to removal of the natural tooth.

In addition to the gingival cuff, a buccal prominence 106 is associatedwith the gingival edge of gingival cuff 104, disposed gingivallyrelative to the crown of each respective tooth (e.g., labeled buccalprominence 106 corresponds to tooth 102). FIG. 1B shows the dental arch100 after central incisor 102 has been removed, leaving a void 108 onceoccupied by the root of tooth 102. The top or most gingival portion ofvoid 108 is the emergence portion 110 of void 108, whose contours aredefined by the shape of the emergence portion of the tooth 102, justbelow the crown portion of the tooth. Also apparent in FIG. 1B is theinterdental papilla 112.

As shown in FIG. 1C, the void 108 is prepared to receive a dentalimplant 114 by drilling into the bone tissue of the underlying jaw boneat the bottom of void 108, after which a dental implant 114 may beinserted therein, as shown in FIG. 1D-1E. FIG. 1D shows a transfercoping 115 or similar structure being used to aid in seating the implant114 into void 108. FIG. 1E illustrates a view down into void 108 oncedental implant 114 has been fully seated within the prepared underlyingbony tissue (and transfer coping 115 has been uncoupled from implant114). Much of the lower portion of void 108 may be filled by dentalimplant 114, while the emergence portion 110 remains unfilled. FIG. 1Fshows installation of a state of the art healing cap or cuff 116, whichcouples into dental implant 114. Healing cap or cuff 116 is typicallyprovided in various sizes, each of which is cylindrical (e.g., each of adifferent diameter and/or height). A healing cap or cuff is selectedfrom the available sizes and coupled into dental implant 114. Healingcap or cuff 116 may remain in place for several weeks (e.g., 1.5 to 6months) while the site heals. As shown in FIG. 1F, because the healingcap or cuff 116 is not anatomically shaped to fill the emergence portion110 of void 108, gaps 118 remain between healing cap or cuff 116 and thegingival walls defining emergence portion 110. Placement of the healingcap or cuff 116 may be the end of what is termed the first stageprocedure. It will be understood that while described in terms ofvarious stages, healing caps or cuffs 116 may be placed in various otheroral surgery procedures (e.g., second stage, immediate placement,subsequent placement, etc.). Similarly, the inventor's anatomicalhealing cap devices, systems and methods may be employed in various oralsurgery procedures (e.g., during a first or second stage procedure, inan immediate placement procedure, in a delayed placement procedure, orin any other appropriate oral surgery procedure). The greatest benefitmay be obtained where the anatomical healing cap devices are placedimmediately or soon after placement of the implant, so that the gingivaltissue is immediately supported, and loss of desired gingival tissuefeatures is minimized.

By way of example, in a subsequent second stage procedure, after ahealing period of at least several weeks, the person may return to thepractitioner's office, the healing cap or cuff 116 may be removed, and apermanent prosthesis may be installed by coupling into implant 114.During the healing period, the gingival tissue surrounding healing capor cuff 116 progressively adapts to the shape provided by healing cap orcuff 116, collapsing into, growing into, or otherwise filling gaps 118.In addition, the height of contour of the gingival cuff tends to becompressed (i.e., reduced) as the tissue between adjacent teeth recedes,the interdental papilla fall or otherwise fill gaps 118, and the buccalprominence 106 recedes so as to be less prominent bucally. As a result,the emergence profile and other desirable gingival features arecompromised. At this stage, even if one were to install a crown or otherprosthesis that were a perfect match to the natural tooth, including thesubgingival emergence portion, it is often too late to recapture theprior characteristics of the surrounding gingival tissue, which havebeen lost. Furthermore, when installing such a prosthesis at this laterstage, the gingival tissue that has grown into gaps 118 is often cutaway or compressed in order to make space for the prosthesis. Suchactivity can lead to subsequent necrosis of the gingival tissue.

Customizable sculptable anatomical healing caps specifically configuredto preserve or restore or create (in the case of missing teeth) as muchof this gingival tissue, its emergence profile, and other features aspossible are disclosed in the inventors' earlier U.S. patent applicationSer. No. 13/347,127 filed. Jan. 10, 2012 and entitled CUSTOMIZABLESCULPTABLE ANATOMICAL HEALING CAPS, SYSTEMS, AND RELATED METHODS, hereinincorporated by reference in its entirety. The present applicationdiscloses casting jigs, and related kits and methods for use inmanufacture of the anatomical healing caps. The casting jigs, kits, andmethods advantageously allow a practitioner to manufacture suchanatomical healing caps himself or herself. Manufacture may be easilyachieved chair-side, on a small scale, or both. Of course, such castingjigs could also be employed in a large-scale manufacture process.

III. Exemplary Customizable Sculptable Anatomical Healing Caps

FIGS. 2A-2E illustrate various views of an exemplary sculptableanatomical healing cap 130 a configured to fill the emergence portion ofa void resulting from removal of an upper central incisor. Sculptableanatomical healing cap 130 a includes an elongate body 132 extendingbetween a proximal end 134 and a distal dental implant insertion end136. Body 132 may be advantageously hollow, including a hollow channel138 with open ends and extending generally along longitudinal axis A soas to allow insertion of coupling screw member 140 into hollow channel138, by which external threads 142 can be coupled into correspondinginternal threads of a dental implant 114.

Sculptable healing cap 130 a advantageously includes an enlarged cuffbody 144 a extending laterally outward from hollow elongate body 132. Inone embodiment, body 132 and body 144 a are integral. In other words,they may be one and the same, such that no separate body 132 is present.This is particularly so where the cuff body 144 a is formed by casting acurable or otherwise settable dental material within a casting jig. Ofcourse, a separate body 132 may be provided in such a casting jigmanufactured embodiment, by casting the cuff body about body 132 (e.g.,body 132 may initially comprise a straw or temporary abutment insertedinto the well of the casting jig, about which the cuff body 144 a isformed. Enlarged cuff body 144 a is disposed between proximal end 134and distal end 136, and advantageously is shaped, as manufactured, toprovide a substantially custom fit so as to fill emergence portion 110of void 108. In the illustrated configuration, cuff body 144 a includesa subgingival or lower portion 146 a and an exposed or upper portion 148a. Subgingival portion 146 a becomes inserted within emergence portion110 of void 108 during use, while exposed portion 148 a residesgingivally above void 108.

Both portions 146 a and 148 a may be shaped to mimic the shape of thenatural tooth which may have immediately prior resided within void 108.In particular, subgingival portion 146 a is shaped to mimic that portionof the natural tooth which resides immediately below the gingivalsurface, so that this portion 146 a mimics the emergence portionincluding the emergence profile of the natural tooth. In order to mimicthe natural tooth contours just below the gingival surface, thesubgingival portion 146 a includes an asymmetrical cross-section and anirregular surface which mimic the emergence portion and emergenceprofile of the natural tooth. This allows portion 146 a to providesubstantial custom filling of emergence portion 110 of void 108resulting from removal of an upper central incisor 102.

Portion 148 a may also be shaped to mimic the shape and contour of thenatural tooth, although portion 148 a resides above void 108. Theemergence profile is defined by the interface between the subgingivalportion 146 a and exposed portion 148 a. In some embodiments, exposedportion 148 a may be omitted, although it may be preferable to includean exposed portion so as to provide a surface that extends somewhatabove the gingival tissue around the emergence profile, to betterpreserve the natural features of the emergence profile gingiva. Forexample, this provides support structure against which the gingivaltissue can be supported and prevented from collapsing, even where theparticular person's emergence profile may differ somewhat from the asmanufactured subgingival portion 146 a that approximates a custom fit.In one embodiment, the exposed portion 148 a does not extend occlusallyto the same extent that a normal natural tooth would. For example,occlusal features, including cusp features of the natural tooth maysimply be omitted (e.g., the occlusal or top surface of the exposedportion 148 a may simply be a generally flat surface, with a holetherein where hollow channel 138 intersects the generally flat surface.

In one embodiment, hollow channel 138 of body 132 may be bounded by acylindrical or other shaped wall, which may or may not extend proximallyabove exposed portion 148 a.

At least subgingival portion 146 a of cuff body 144 a comprises asculptable material so that a practitioner can easily remove selectareas of portion 146 a, can add to (i.e., build up) portion 146 a with adental material that will adhere (e.g., a curable dental material), orboth so that portion 146 a can be chair-side fully customized to providean exact, custom fit that fills emergence portion 110 of void 108.Sculptability is advantageous because while the shape and size of theemergence portion 110 of void 108 is more or less the same for differentpersons for a particular given tooth position (e.g., generally allpersons will have very similar emergence portions for their uppercentral incisors), individual people do vary somewhat from individual toindividual, and the ability to easily remove material, add material, orboth relative to portion 146 a allows the practitioner to fullycustomize portion 146 a for a given emergence portion 110 of void 108.

Of course, in some embodiments, more than a single size cuff body may beprovided for any given tooth position. For example, children may exhibitdifferently sized emergence portions as compared to adults for a giventooth position. Similarly, some individuals may have particularly largeor small teeth, so that their emergence portions may vary somewhat fromthe normal or average size. As such, in one embodiment, different sizes(e.g., normal adult size, a “large” adult size, a “small” adult size,and/or a child size) may be provided, such that the practitioner maychoose the most appropriate size, which may then be fully customized bysculpting. Such differences in sizing can be provided within the castingjigs of the present invention. Because the cuff body is sculptable, apractitioner may simply add to or remove material as needed to achievethe desired size.

In one embodiment, subgingival portion 146 a may intentionally be sizedto be slightly larger than the typical average emergence profile, sothat the practitioner may shave or otherwise remove portions therefrom(e.g., with a dental burr, scalpel or other suitable tool) immediatelyprior to placement. This may be advantageous as it may be easier andless time consuming to typically require removal of material rather thansupplementation, where material must be added to fully customize thesubgingival portion 146 a. In some embodiments, it may be expected thatlittle or no modification (either removal or adding to) may be required.As such, the size and shape provided is already substantially configuredto fill the person's emergence portion 110 of void 108 (withsubstantially no gaps), providing the same emergence profile as wasprovided by the natural tooth to thereby support the gingival tissue.

In one embodiment, the subgingival portion 146 a, and preferably theentire cuff body 144 a is therefore not formed of metal, but comprises amaterial that may be easily and conveniently shaved or cut away, as wellas added to. Such suitable materials include any of various plasticmaterials, dental composite materials, or other materials that can bereadily customizable through use of a dental burr, scalpel, or othersuitable tool. When manufactured with use of the present inventivedental jigs, cuff body 144 a may be formed from a curable or otherwisesettable dental material (e.g., dental composite, etc.) that may bedispensed into the well of the casting jig so as to form the desiredcuff body 144 a. In one embodiment a radiopaque filler may beincorporated into the plastic or composite so that the subgingivalstructures of the healing cap can be viewed by x-ray or other imagingtechnique. Such materials also advantageously will readily bond tocurable or other suitable adhering dental materials applied theretowhere it is desired to add size or adjust contour to the asmass-manufactured cuff body. In one embodiment, the entire elongate bodyand enlarged cuff body may comprise a single piece of material (e.g.,plastic or composite material).

In one embodiment, the exterior surface of cuff body 144 a, particularlysubgingival portion 146 a, may be treated for stimulation of bone orother tissue growth. For example, the material of body 144 a or portion146 a may be particularly selected so as to stimulate growth (e.g., acalcium containing material such as hydroxyapatite or similar bonegrowth promoting material), or the surface may be mechanically (e.g.,roughened, smoothed, specific texture patterned), chemically, orotherwise treated to stimulate desired growth. While stimulation of bonegrowth may be desired, in another embodiment, material selection ortreatment may be specifically configured to promote soft tissue growth.

In one embodiment, the distal dental implant insertion end 136 ofsculptable anatomical healing cap 130 a may include a locking member 150with a non-circular perimeter configured for insertion into acorrespondingly shaped proximal end of a dental implant 114. In theillustrated configuration, the locking member 150 is hexagonal. Otherconfigurations similarly configured to lock against rotation will bereadily apparent to one of skill in the art (e.g., triangular, 4-sided,5-sided, use of non-circular curved sides (e.g., an oval), combinationof straight and curved sides, etc.). This locks the healing cap 130 aagainst rotation once inserted within dental implant 114. Any suitableanti-rotation locking mechanism, including those proprietary to variousdental implant manufacturers within the art, may be employed. Indeed, aswill be explained below, the casting jigs of the present invention mayprovide for the ability to cast such a proprietary shaped lockingmechanism as a part of the as manufactured healing cap through use of acorresponding dental implant during casting.

In another embodiment, the distal dental implant insertion end 136 mayinclude a circular locking member 150′ (see FIG. 2F). In anotherembodiment, no locking member at all is provided (see FIG. 2G). Any suchembodiments may be prepared through use of the inventive casting jigs.In the embodiment of FIG. 2G, external threads 142 are simply coupledinto corresponding internal threads of dental implant 114, and the shapeof subgingival portion 146 a itself can serve to prevent rotation, asthis portion is non-circular and engages against the gingival tissuebounding emergence portion 110 of void 108. Other coupling mechanismsbetween the healing cap and dental implant 114 are possible. Forexample, the location of internal and external threads may be switched(i.e., internal threads on healing cap, and corresponding externalthreads on dental implant). Various other suitable coupling mechanismswill be apparent to one of skill in the art in light of the presentdisclosure.

In one embodiment, a removable grippable handle may be provided at theproximal end 134 of body 132. As shown in FIG. 2H, a grippable handle152 may be provided. Handle 152 may include a shaft 154 extendinglaterally outwards from elongate body 132, cuff body 144 a, or both. Inone embodiment, shaft 154 may be disposed adjacent the buccal surface ofbody 132, cuff body 144 a, or both, which advantageously orients thehandle in the most suitable position during insertion into void 108. Asshown, handle 152 may be generally T-shaped, including a cross-bar 156atop or near end of shaft 154. Another shaft 154′ may be providedopposite shaft 154, providing two points disposed laterally outward foreasy gripping. Shaft 154, shaft 154′ and/or cross-bar 156 providesurfaces that can be easily gripped by dental pliers or another suitabletool available to the practitioner. Shaft 154′ and T-shaped handle 152may be cast in the inventive casting jig by simply providing theseextensions at a top surface of the well used in forming the cuff body,as will be shown and described below in conjunction with FIG. 5. Oncethe healing cap is placed within void 108, handle 152 (including shaft154′) may be removed (e.g., cut away).

While the illustrated configuration is shown with cuff body 144 agenerally aligned with axis A of channel 138, in another embodiment, theaxis A of channel 138 may be offset relative to an axis of cuff body 144a. Similarly, cuff body 144 a may not be “on center” relative to axis Aof threaded portion 142. This may be beneficial where the natural tooth(and thus void 108) is mis-aligned relative to what would be “normal”.Such configurations allow the practitioner to account for suchsituations.

It will be understood that anatomical healing caps may also be providedfor other tooth positions, such as upper lateral incisors, uppercuspids, upper bicuspids, upper molars, lower incisors, lower cuspids,lower bicuspids, and lower molars. It will be apparent that a singleconfiguration may sometimes be suitable for two or more different toothpositions (e.g., a single bicuspid configuration may be used for bothfirst and second bicuspids, a single molar configuration may be used forboth first and second molars, a single lower incisor configuration maybe used for all lower incisors, etc.). Additional details of theanatomical healing caps are disclosed in U.S. patent application Ser.No. 13/347,127 filed Jan. 10, 2012 and entitled CUSTOMIZABLE SCULPTABLEANATOMICAL HEALING CAPS, SYSTEMS, AND RELATED METHODS, alreadyincorporated by reference in its entirety.

FIGS. 3A-3B illustrate healing cap 130 a of FIG. 2B in combination witha temporary crown form 160 that may be used with the healing cap inchair-side manufacture and placement of a temporary provisional crown orother prosthesis.

FIGS. 1A-1E discussed above show the same steps to be taken wheninstalling the anatomical healing caps. As shown in FIGS. 1A-1E, thetooth is removed, the void 108 is prepared to receive dental implant114, and dental implant 114 is anchored into the underlying bony tissueof the jaw bone. Rather than installing the cylindrical state of the arthealing cap or cuff shown in FIG. 1F, the appropriate sculptableanatomical healing cap is selected (e.g., healing cap 130 a configuredfor filling the emergence portion 110 of void 108 of an upper centralincisor).

The as manufactured shape and contours, which are a very close actualemergence portion 110 and emergence profile of the void 110 and tooth102, may be custom modified as shown in FIG. 4A by removing selectportions of cuff body 144 a (particularly subgingival portion 146 a)with a dental burr 180 or other suitable tool. As shown in FIG. 4B, ifnecessary, the practitioner may build up portions of cuff body 144 a(particularly subgingival portion 146 a) by applying and curing a dentalmaterial (e.g., light-curable, chemically-curable, heat curable, orother adhering dental material) 182. This is possible because at leastthe subgingival portion 146 a of cuff body 144 a is formed of a curableor otherwise settable material that is easily removed with the aid of adental burr 180 or similar tool. Similarly, the material of body 144 astrongly bonds to curable material 182, should such additions bedesired. For example, one may employ the same curable or otherwisesettable dental material employed in casting the cuff body 144 a in thecasting jig to add material, if desired. By removing material, addingmaterial, or both, the practitioner is advantageously able to relativelyquickly customize at least the subgingival portion 146 a of the cuffbody 144 a so that it provides a perfect or near perfect fit, fillingthe emergence portion 110 of void 108, with substantially no gaps.

As shown in FIG. 4C, the healing cap 130 a is placed within void 108 sothat subgingival portion 146 a fills the emergence portion 110 withsubstantially no gaps, and provides an emergence profile between thegingival tissue emergence portion 110 that is substantially identical tothat provided by the natural tooth prior to its removal. The exposedportion 148 a resides just above the gingival tissue, which is helpfulin ensuring that all gingival tissue is fully supported, particularlywhere there may be some small degree of variability in the contours ofthis gingival tissue between one patient and another for a given toothposition.

FIG. 4D shows the exposed portion 148 a having been completely removed(e.g., it may be easily cut away with a burr or other convenient dentaltools if desired). This view perhaps best shows how the emergenceprofile 111 surrounding the location where the healing cap 130 a emergesfrom the void 108 is perfectly or nearly perfectly matched to thegingival tissue so that substantially no gaps are present (compare withthe gaps that are common with state of the art healing caps shown inFIG. 1F). Because subgingival portion 146 a is provided with theanatomical shape of the emergence portion 110 of void 108, the variouscharacteristic features of gingival cuff 104 are preserved, includingpreservation of the full height of contour of gingival cuff 104, theinterdental papilla 112, and the buccal prominence 106.

As shown in FIG. 4E, a temporary or provisional crown 190 may bechair-side formed over the sculptable anatomical healing cap 130 a,while preserving access to underlying hollow channel 138 of healing cap130 a.

When a permanent crown (typically custom prepared in an off-site dentallab) is ready for installation, the healing cap (and any temporary crownformed thereon) may simply be removed from void 108 by accessingcoupling screw member 140 through hollow channel 138. The permanentcrown may then be inserted within void 108, taking the place of healingcap 130 a. Of course, the permanent crown may be provided with thenecessary shape to fill emergence portion 110, so that the gingivaltissue surrounding void 108 which has been preserved through the use ofsculptable anatomical healing cap 130 a can continue to be preserved.

The use of the anatomical sculptable healing cap provides for thepreservation of various gingival features that are characteristic ofnatural teeth, including the gingival cuff, height of contour, theemergence profile, the interdental papilla, and the buccal prominence.These features are typically progressively lost over the weeks and/ormonths following first stage treatment where insufficient structure isprovided for supporting the gingival tissue at the site where the toothonce was. Use of the healing caps, systems, and methods allow thesefeatures to be maintained, rather than progressively lost followingfirst stage treatment and before placement of a custom permanent crown.

III. Exemplary Casting Jigs

FIG. 5 shows an exemplary casting jig 200 for use in manufacture of thecustomizable sculptable anatomical healing caps. Casting jig 200includes body 202, which includes one or more wells 204 formed therein.Each well 204 is open at a proximal end 206 and may include a socket 210at a distal end 208 (FIG. 6). Open proximal end 206 allows introductionof a curable or otherwise settable dental material from which ananatomical healing cuff body (e.g., body 144 a) is formed. Distal end208 may include a socket 210, which allows a dental implant or dentalimplant analog 212 to be releasably received therein. Each well 204includes a negative shape corresponding to an anatomical healing cuffbody of a given tooth position. As described above relative to theanatomical healing caps and cuff bodies, each such correspondingnegative shape has an asymmetrical cross-section and an irregularsurface so that an anatomical healing cuff body having said shape (andformed by filling said well with a curable or otherwise settable dentalmaterial) is configured to provide substantially custom filling of atleast an emergence portion of a void where a natural tooth once emergedfrom a void or where a tooth would have emerged from a void.

Casting jig 200 is shown as including a plurality of wells, eachdifferently configured. For example, one or more wells may be configuredto produce healing caps configured for molar placement, one or more maybe configured to produce healing caps configured for bicuspid placement,one or more may be configured to produce healing caps configured forcuspid placement, one or more may be configured for upper lateralincisor placement, one or more may be configured for upper centralincisor placement. Similarly, wells may be configured to produce healingcaps specifically configured for placement in the various lower toothpositions. By way of example, one casting jig may include all the neededwells for producing all of the upper tooth positions, while a separatecasting jig may be provided for producing all of the lower toothpositions. In another embodiment, all positions may be provided within asingle casting jig. In another embodiment, only a single well may beprovided in a casting jig, specific to tooth configuration. Thus, itwill be readily apparent that any number and configuration of wells maybe provided within the inventive casting jigs.

While FIG. 6 shows an embodiment in which well 204 is vertically alignedover implant or implant analog 212, this is not required. For example,in some embodiments, a longitudinal axis of healing cuff body 144 a (andthus well 204) may be off center and/or out of axial alignment relativeto the longitudinal axis of implant or implant analog 212. Such offcenter or out of axial alignment configurations may be desirable whereteeth are crowded, or where space for anchor placement is otherwise notoptimal (e.g., where the void for implant placement is not axiallyaligned and centered below the healing cap to be placed). Suchconfigurations provide flexibility in void preparation and implantplacement to the practitioner.

As seen in FIG. 6, implant or implant analog 212 may be retained withinsocket 210 in the desired position and orientation relative to well 204by an implant housing 214 that serves as a cage, holding implant orimplant analog 212 in place. As perhaps best seen in FIG. 6, casting jig200 may include an upper portion 216 and a lower portion 218. Upperportion 216, which defines at least a portion of well 204, may be formedof any suitable material (e.g., plastic, metal, stone, an elastomericmaterial, etc.). In one embodiment, upper portion 216 is formed of anelastomeric material (e.g., rubber, silicone, etc.) so as to provideupper portion 216 adjacent well 204 with the ability to “give”,facilitating easier removal of a cast healing cap (e.g., cap 130 a). Inanother embodiment, upper portion may comprise a more rigid material(e.g., rigid plastic, stone, metal, etc.). Use of an elastomericmaterial may facilitate easier removal of cast healing caps from wells204, and may also prevent or otherwise minimize any tendency of upperportion 216 adjacent wells 204 to chip or crack, which might otherwisetend to occur with some materials (e.g., stone).

Lower portion 218 may be formed of the same or a different material ascompared to upper portion 216. In one embodiment, lower portion 218 maycomprise a material that is more rigid than upper portion 216. Forexample, lower portion 218 may comprise stone, metal, or a rigidplastic, while upper portion 216 may comprise an elastomeric material.

Another embodiment may not necessarily include discrete upper and lowerportions formed of different materials, but may include an elastomericmaterial surrounding wells 204 (although the entire upper portion 216may not be formed of the elastomeric material). In other words, portionsof casting jig 200 adjacent to wells 204 (and defining the bounds ofwells 204) may comprise an elastomeric material, while other portions ofcasting jig 200 may be formed of a more rigid material. In one suchembodiment, the elastomeric material may be surrounded by the more rigidmaterial.

Implant housing 214 advantageously holds implant or implant analog 212in a desired position and orientation relative to distal end 208 of well204. Implant housing 214 may also advantageously allow removal andinterchange of one implant or implant analog 212 with another implant orimplant analog. For example, there exist scores of dental implantmanufacturers, each often including proprietary structural features(e.g., proprietary locking recess shapes). In addition, where a healingcap is to be seated within and coupled to a given implant, the healingcap should preferably have corresponding shaped locking structure tocorrespond to that of the implant. For this reason, one typicallypurchases implants and healing caps from the same manufacturer so thatthey are compatible with one another. Because the present casting jigsallow a practitioner to manufacturer their own anatomical healing caps,it would be advantageous to provide a mechanism by which the anatomicalhealing caps may be manufactured so as to be compatible with a desiredmanufacturer implant to be employed. Use of the manufacturer's implantor implant analog in socket 210 of casting jig 200 provides the producedhealing cap with the desired corresponding locking structure (e.g.,locking structure 150 of FIG. 2A).

Implant housing 214 allows one to remove implant or implant analog 212through an opening 221 in bottom surface 220 of casting jig 200, afterwhich an implant or implant analog of another manufacturer may beinserted into socket 210, housed within implant housing 214. Thus, thepractitioner or other user of casting jig 200 is free to employwhichever implant or implant analog manufacturer he or she desires.Placement of the desired implant or implant analog 212 within socket 210allows one to cast the produced healing cap so as to include the desiredlocking structure that corresponds to locking recess 225 of implant orimplant analog 212.

Separate, specifically configured implant housings may be provided foreach implant. For example, the exterior surface and profile of eachimplant or implant analog 212 may differ from manufacturer tomanufacturer. Thus, a different implant housing may be provided for eachmanufacturer's implants and implant analogs. Different, specificallyconfigured implant housings 214 may be provided to correspond to eachimplant or implant analog. For example, an interior profile 222 of agiven implant housing 214 may be specifically configured to mate with orotherwise retain the corresponding implant or implant analog 212. Theexterior profile 224 of all implant housings 214 may be identical,allowing any of the implant housings to be inserted into socket 210, foruse within casting jig 200 for a desired tooth position. Thus, thesystem allows one to employ any of dozens of various implant or implantanalog configurations (e.g., all configured for use with a given toothposition) within the socket adjacent the well configured to produce ahealing cap for that given tooth position.

In another embodiment, implant housing 214 may be suitable for useacross multiple differently configured implants or implant analogs 212.For example, where implant housing 214 is formed of an elastomericmaterial, so long as the various implants or implant analogs includeroughly similar sizing, the elastomeric deformation ability of theimplant housing 214 may allow housing 214 to deform to accept andappropriately “cage” similar, but differently configured implants orimplant analogs 212.

The configuration of casting jig 200 thus provides great flexibility inallowing the practitioner to manufacture anatomical healing caps for usewith any desired dental implant. All that is required is that the userinsert the desired implant or implant analog 212 into socket 210 (withaccompanying housing 214), and the formed anatomical healing cap willautomatically include the necessary structural features so as to allowits use with that particular implant.

Stated another way, while currently a practitioner is required topurchase healing caps from a manufacturer for perhaps as much as $40 to$80 each, the casting jig allows one to make their own healing caps,reducing the cost of components to be purchased. In addition, thepractitioner manufactured anatomical healing caps provide vastlyimproved results with respect to preservation of the desirable aestheticgingival features as compared to existing healing caps. All this ispossible at substantially reduced cost. For example, a practitioner maymake his or her own anatomical healing cap for significantly reducedcost as compared to the large purchase price of an inferior state of theart healing cap.

For example, implants typically include an anti-rotational lockingrecessed connection 225 (e.g., a hex recess) in the head of dentalimplant or implant analog 212. No matter the specific configuration ofsuch a proprietary locking recess of a given implant or implant analog,the produced healing cap can be formed so as to include thecorresponding mating feature as a result of the locking recess of theimplant or implant analog being used to close the distal end of well 204during casting. In other words, the shape defined by locking recessconnection 225 can be cast into the distal end of the manufacturedhealing cap. By way of example, if a given dental implant or implantanalog 212 includes a hex recess (e.g., recessed connection 225), theformed anatomical healing cap will include the corresponding hex lockingmember 150 (see FIG. 2A) at its distal end, as a result of the curableor otherwise settable material being introduced into the hex recess 225of the implant as well as the adjacent well 204, disposed thereabove. Aswill be described below, insertion of an elongate body (e.g., a wrench,a Q-tip, a hollow straw or other suitable tool) can be used to form andpreserve a hollow access channel 138 through the practitionermanufactured healing cap to allow subsequent coupling of the producedhealing cap to a dental implant with a screw 140.

While shown with implant housing 214, it will be understood that in someembodiments, implant or implant analog 212 may be directly retained bythe exterior walls and any retaining features (e.g., a snap fit, etc.)of socket 210. In another embodiment, retention of dental implant ordental implant analog 212 by socket 210 is indirect, (e.g., throughimplant housing 214), as described above in conjunction with FIGS. 6-7.Other retention mechanisms may alternatively be employed to releasablyretain dental implant or implant analog 212 within socket 210, and suchmechanisms are within the scope of the present invention.

For example, in one embodiment, the socket may include an elastomericlining, so as to allow one to simply press a desired implant or implantanalog 212 through opening 221 in bottom surface 220 up into positionrelative to well 204. Such a configuration may appear similar to thatshown in FIG. 6, but in which implant housing 214 is glued or otherwisefixedly retained within socket 210. The bottom portion of housing 214shown closed in FIG. 6 (where the two halves of housing 214 cometogether) might be open, allowing one to insert therein a desiredimplant or implant analog 212. The elastomeric nature of such a liningor housing may hold the implant or implant analog 212 in place duringcasting.

Housing 214 may include a projection (e.g., an annular ring) 226 thatsnap fits within a corresponding annular groove 228 formed within socket210 in lower portion 218. Other retention mechanisms for retaininghousing 214 within socket 210 will be apparent to one of skill in theart. In a similar manner, interior surface 222 of housing 214 mayinclude a projection 230 configured to snap fit within a correspondingannular groove 232 formed within implant or implant analog 212. Wherehousing 214 comprises an elastomeric material, no specific couplingstructure (e.g., projection 230 and corresponding groove 232) may berequired, as the elastomeric characteristics of housing 214 may besufficient to grip and hold the exterior surface of implant or implantanalog 212 in place, particularly once the assembly (implant analog 212and housing 214) is inserted into socket 210. Similarly, such grippingcharacteristics of implant housing 214 or of adjacent lower portion 218may be sufficient to hold implant housing 214 and implant or implantanalog 212 within socket 210 by friction fit, so that no annular ring226 or corresponding groove 228 may be present.

Housing 214 may include a handle adjacent bottom surface 220 or othermeans to facilitate gripping and removal of housing 214 from socket 210.For example, in the illustrated configuration, socket 210 widensadjacent bottom surface 220 at 234, allowing one to grip the exteriorsides 224 of housing 214 and pull it out of socket 210. Such anembodiment may advantageously preserve the ability of casting jig 200 tolay flat (e.g., bottom surface 220), without any handles extendingbeyond bottom surface 220. Another embodiment may include one or moregrippable handles on a bottom surface of housing 214, which handles maybe recessed within socket 210, so as to preserve the ability of thecasting jig to lay flat.

FIGS. 8-9A illustrate introduction of curable or otherwise settabledental material 236 into well 204. Prior to introduction of flowabledental material 236 into well 204, an elongate body (e.g., wrench 238)may be inserted into screw 140, which prevents flowable dental material236 from filling threaded portion 227 of implant or implant analog 212.In another embodiment, where no screw is present, the elongate body maybe directly inserted into threaded portion 227. For example, elongatebody 238 may have a diameter or thickness adjacent its distal end thatis sized so as to cover or plug threaded portion 227, while not being solarge in diameter or thickness to cover or plug the entirety of recessedconnection 225. In either case, as perhaps best seen in FIG. 9A,flowable dental material 236 may be allowed to enter recessed connection225 so that the produced healing cap includes a hexagonal locking member150 (or other anti-rotational shape), but in which the central portionof the locking member 150 is hollow, preserving hollow access channel138 therethrough. FIG. 10 shows a produced healing cap 130 a, inexploded view with coupling screw 140 and implant analog 212. Where ascrew is present, the screw may actually become integral with thehealing cap, so that it cannot be later removed (e.g., similar to asshown in FIG. 11). Once material 236 is cured, backing out of screw 140with wrench 238 may serve to unseat healing cap 130 a from well 204.

While the method is illustrated in FIG. 9A with elongate body 238comprising an implant wrench, it will be understood that other elongatebodies may be alternatively employed. For example, even a Q-tip, anappropriately dimensioned hollow straw, or solid rod may be inserted toachieve a similar result. Where a wrench or other solid elongate memberis employed, it may be important that the cured or set dental material236 not adhere strongly to wrench 238 to allow its removal. Where ahollow straw is employed, removal of the straw may not be required. Oncethe wrench or other elongate body 238 has been removed, one may employ adental burr or similar tool to widen central access channel 138, ifdesired. In another embodiment, one may place a removable collar aboutelongate body 238 prior to filling well 204, which collar can be removedwith elongate body 238 after curing or setting, similarly resulting in awider central channel 138.

In one embodiment, the elongate body inserted into well 204 may comprisea temporary abutment 238′ purchased from a dental product manufacturer(e.g., the same manufacturer who provided the implant or implantanalog). Such a temporary abutment may be configured similar to body 132shown in FIGS. 2A-2E. Such an embodiment is shown in FIG. 9B. Theabutment 238′ may already include any needed locking structure (e.g.,hex head 150) corresponding to recess 225. Thus, in such a case, theintroduced curable or otherwise settable dental material 236 need notenter into recess 225 (which recess may conveniently be entirely blockedby corresponding locking structure already disposed on temporaryabutment 238′, and seated within recess 225 implant or implant analog212).

In other words, temporary abutment 238′ may be used as a core aroundwhich the anatomical healing cuff body 144 a is cast within well 204.The abutment 238′ may be coupled to implant 212 by screw 140. In anotherembodiment, no screw may be employed. Where screw 140 is present, thescrew may be removed through channel 138. Thus, in this embodiment,screw 140 may not become bonded and integral with cured or set dentalmaterial 236 of the anatomical healing cap. Use of a temporary abutmentmay be particularly suitable when producing anatomical healing capshaving relatively large, wide healing cuff bodies (e.g., bicuspids ormolars). For smaller teeth, one may find the temporary abutment to largeto be readily insertable into well 204 while allowing introduction ofcurable or otherwise settable dental material 236 therearound. Forexample, many such commercially available temporary abutments includesome lateral extension beyond the simple cylindrical core body 132 shownin FIGS. 2A-2E (e.g., compare FIG. 9B). A straw configured ascylindrical core body 132 could similarly be employed.

FIG. 9C shows another alternative similar to that shown in FIG. 9B, butin which temporary abutment 238″ is of a lower profile, so that it doesnot extend out the top of well 204. In order to preserve an accesschannel 138, wrench 238 is inserted therein, after which the curable orsettable dental material 236 is introduced into well 204. Similar to theembodiment shown in FIG. 9B, removal of screw 140 may be possiblefollowing fabrication of the anatomical healing cap.

Examples of such temporary abutments that may be used as a core aboutwhich an anatomical healing cuff body is formed are available fromvarious manufacturers, including Glidewell Laboratories, located inNewport Beach, Calif. Such temporary abutments employed as a core may beformed of any of various materials (e.g., including, but not limited toplastics, such as polyether ether ketone (PEEK), metal, ceramic (e.g.,alumina, zirconia), etc.). Such temporary abutments array be formed byany suitable technique (e.g., casting, molding, machining, etc.)

In some embodiments (e.g., as shown in FIG. 9A), a screw may engagethreaded portion 227 of implant or implant analog 212. An implant wrenchmay be inserted in conjunction with such a screw to preserve an accesschannel 138. Such a screw may be retained within the produced healingcap, providing a healing cap with a screw already incorporated therein.In one embodiment, the head of any such screw may extend through thelength of any locking member (e.g., 150) to reinforce this otherwiserelatively thin neck region of the produced healing cap. For example,one may simply back a typical coupling screw out a couple of turns oruse a screw that is sufficiently long so as to extend through the narrowneck associated with locking member 150, into body 144 a. Such anembodiment including a longer screw is shown in FIG. 11. An example ofsuch a screw 140′ may include an enlarged head 240, an undercut centralportion 242 of decreased diameter relative to the enlarged head, and adistal threaded end 244, in which the threaded end defines a diameterthat is intermediate the diameter of the enlarged head and the centralportion. Such screw configurations (or backing out of a standardcoupling screw, which is relatively shorter) reinforces the more fragileportion of healing cap 130 a to prevent a break from occurring adjacentlocking member 150.

Any suitable curable or otherwise settable dental material may beemployed. Examples of such composite materials include, but are notlimited to, glass ionomer cements, zinc polycarboxylate cements, andacrylic based curable compositions, for example, ACCESS CROWN, availablefrom Centrix, located in Shelton, Conn. In one embodiment, the curableor otherwise settable dental material may comprise a radiopaque filler,e.g., a zirconia filled dental composite material. In addition tozirconia fillers, fillers including compounds of lanthanum, strontium,barium, zinc (e.g., zinc oxide), or combinations thereof may also beprovided in order to provide radiopacity.

In one embodiment, radiographic and/or position markers may beincorporated into the anatomical healing cap 130 a. For example, suchmarkers could be inserted into a well of a casting jig, which marker maybecome incorporated into the resulting anatomical healing cuff body thatis cast. In another embodiment, such markers may be included within atemporary abutment employed as a core about which the anatomical healingcap is formed. The markers would thus become a part of the healing cap.Such markers may be used to determine orientation, position, or otherspatial information through a digital scanning or imaging process (e.g.,CT scan, ultrasound, etc.) of the patient. Such markers may comprise anyof the described radiopaque materials described above, or other suitableradiopaque materials (e.g., radiopaque metal alloys).

While it has been described that the casting jig may be employed tomanufacture anatomical healing caps, and such manufacture may beachieved chair-side, it will be readily understood that a practitionermay choose to manufacture any number of anatomical healing caps prior toneeding them, thus, “chair-side” is to be broadly construed, includingwhere one may manufacture the anatomical healing cap prior to requiringits use. For example, a practitioner may choose to manufacture a smallinventory of anatomical healing caps, which are kept and used as needed.That said, many curable or otherwise settable dental compositions cureor set up within about 3 minutes or less, such that true chair-sidemanufacture of a desired anatomical healing cap is certainly possible.

Another embodiment may not necessarily employ a socket at a distal endof the well configured to releasably receive therein a dental implant ordental implant analog. For example, for manufacture of a politic 130 a′,no coupling to a dental implant is needed. Thus, one may simply cast adesired pontic having the shape of the anatomical cuff body, and thepontic may be positioned into the prepared void in the patient's jawbone (without the need for any anchoring implant). The pontic may ratherbe anchored to adjoining teeth on one or both sides of the pontic. Suchpontics would be similar to the described healing caps, but would notrequire any mechanism for coupling to a dental implant. In addition,because no coupling to an implant is required, no central access channel138 may be needed. Thus, the pontic may be solid, without any hollowaccess channel. Such an embodiment is shown in FIG. 12.

9B

Another embodiment similar to that shown in FIG. 9B is described inconjunction with FIG. 9D, For example, the entire casting jig 200 (e.g.,both upper and lower portions 216 and 218) may be formed of the samematerial, e.g., comprising a single integral piece of material. Such acasting jig 200 may be formed of an elastomeric material (e.g., siliconeor polyvinyl siloxane), or a single piece of plastic. The casting jigcould be molded around the implant analog 212 (e.g., by introducingsilicone resin into a container around the analog, and allowing thesilicone to set). Rather than including an implant housing 214 thatserves as a cage (see FIG. 9B) and the implant analog 212 being insertedfrom the bottom of the casting jig, the analog may be removed orinserted into the casting jig 200 from above, at the top of the castingjig (e.g., through well 204). A hole or opening 221 in bottom surface220 of casting jig 200, may be provided through which an implement maybe inserted to push implant analog 212 upwards, into well 204, where itmay be removed, as desired (e.g., when it is desired to remove a formedanatomical healing cap, the assembly of the healing cap and coupledanalog may be upwardly pressed out).

As described in conjunction with FIG. 9B, a commercially availabletemporary or interim abutment 238′ may be used as a core about which theanatomical healing cap is formed. Temporary abutment 238′ may beinserted from above into analog 212. The typically keyed recess 225 ofanalog 212 may have been removed (e.g., drilled out), making the analog212 generic to any given key. The screw 140 may be screwed down tightlyinto threaded portion 227 of analog 212, securing the two together.Bis-acrylic or any other suitable curable or otherwise settable materialmay be introduced into drilled out recess 225 at the head of analog 212,to form a keyed recess structure within analog recess 225 thatcorresponds to the keyed protrusion structure provided by temporaryabutment 23W. In this way, a generic analog 212 may be used with anyproprietary keyed structure provided with commercially availabletemporary abutments 238′. Analog 212 may include a transversethrough-hole 246 or similar transverse recess that fills with such asettable material, helping to retain the his-acrylic within analogrecess 225 once the settable material sets or cures. The aboveprocedures may be carried out with the analog and temporary abutment238′ located outside of the casting jig.

At this stage, the analog 212 and temporary abutment 238′ are placedwithin casting jig 200 if not already there, with analog 212 in socket210 of casting jig 200. Both may be introduced through the top ofcasting jig, via well 204. Where the casting jig is formed of anelastomeric material, the flexibility and elastic nature of the materialsurrounding socket 210 may allow easy insertion and withdrawal of analog212, as needed. With analog 212 in socket 210 and temporary abutment238′ screwed into analog 212, bis-acrylic or another suitable settabledental material 236 may be introduced into well 204 to form the desiredanatomical healing cap, including the buccal and lingual side handlelateral extensions 152, and 154′. Providing the T-shaped buccal sidehandle 152, and an oppositely disposed lingual handle extension 154′ isquite advantageous, as it provides two points disposed laterallyoutward, on the buccal and lingual sides for easy gripping andpositioning. Integrally formed handle portions 152 and 154′ may easilybe removed (e.g., cut away) once the healing cap is placed within thevoid 108, in implant 114. The presence of buccal and lingual handleextensions 152 and 154′ is further advantageous as they provide areadily visible indicator of the correct orientation of the healing capas it is seated within implant 114.

As used in this specification and the appended claims, the singularforms “a,” “an” and “the” include plural referents unless the contextclearly dictates otherwise.

The present invention can be embodied in other specific forms withoutdeparting from its spirit or essential characteristics. Thus, thedescribed implementations are to be considered in all respects only asillustrative and not restrictive. The scope of the invention is,therefore, indicated by the appended claims rather than by the foregoingdescription. All changes that come within the meaning and range ofequivalency of the claims are to be embraced within their scope.

The invention claimed is:
 1. A casting jig for manufacture ofcustomizable sculptable anatomical healing caps, the casting jigcomprising: a body including one or more wells within the body, eachwell being open at a proximal end thereof and having a negative shapecorresponding to an anatomical healing cuff body of a given toothposition, each respective anatomical healing cuff body negative shapehaving a cross-section and a surface so that an anatomical healing cuffbody having said shape provides substantially custom filling of at leastan emergence portion of a void where a natural tooth once emerged fromthe void or where a tooth would have emerged from a void; and a socketat a distal end of each well configured to releasably receive therein adental implant or dental implant analog wherein an upper portion of thewell defines lateral buccal and lingual handle extensions so that amanufactured anatomical healing cap includes a laterally extendingbuccal handle extension and an oppositely disposed laterally extendinglingual handle extension, the buccal and lingual handle extensions beingintegrally formed with the healing cuff body.
 2. The casting jig asrecited in claim 1, further comprising a dental implant or dentalimplant analog received within the socket of at least one of the one ormore wells.
 3. The casting jig as recited in claim 2, wherein thecasting jig further comprises an opening in a bottom surface of thecasting jig at the bottom of the socket to allow a user to push theanalog out the top of the casting jig, through the well.
 4. The castingjig as recited in claim 2, wherein the dental implant or dental implantanalog includes a recessed connection without any keyed structuretherein to allow insertion of a variety of differently configuredtemporary abutments to be interchangeably releasably retained within thedental implant or dental implant analog.
 5. The casting jig as recitedin claim 1, wherein at least an upper portion of the body of the castingjig surrounding the one or more wells comprises an elastomeric materialto facilitate easier removal of a manufactured anatomical healing cap.6. The casting jig as recited in claim 5, wherein the entire body of thecasting jig comprises a single integral piece of elastomeric material.7. The casting jig as recited in claim 1, wherein each respectiveanatomical healing cuff body negative shape has anasymmetrical-cross-section and an irregular surface.
 8. A casting jigfor manufacture of customizable sculptable anatomical healing caps, thecasting jig comprising: a body including one or more wells within thebody, each well being open at a proximal end thereof and having anegative shape corresponding to an anatomical healing cuff body of agiven tooth position, each respective anatomical healing cuff bodynegative shape having a cross-section and a surface so that ananatomical healing cuff body having said shape provides substantiallycustom filling of at least an emergence portion of a void where anatural tooth once emerged from the void or where a tooth would haveemerged from a void; an upper portion of the one or more wells defininglateral buccal and lingual handle extensions that extend laterallybeyond the healing cuff body of a manufactured anatomical healing cap sothat a manufactured anatomical healing cap includes a laterallyextending buccal handle extension and an oppositely disposed laterallyextending lingual handle extension, the buccal and lingual handleextensions being integrally formed with the healing cuff body; and asocket at a distal end of each well configured to releasably receivetherein a dental implant or dental implant analog; wherein the entirebody of the casting jig comprises a single integral piece of elastomericmaterial.
 9. The casting jig as recited in claim 8, wherein eachrespective anatomical healing cuff body negative shape has anasymmetrical-cross-section and an irregular surface.